1. Strengths & Limitations of existing data sources Julia Critchley Simon Capewell

2. MONICA Project Advantages: Comparable and reliable data
Hot-cold pursuit to identify suspected events in all countries
All events validated during registration period
Limits:
Coverage (only some areas of country)
Age range (35-64)
Cost
Dated [ ]

3. HFA DB

4. HFA DB

6. CHD rates & Life expectancy

7. HFA DB (European Health For All Database)
Advantages:
Covers all countries
User friendly web access
Nice graphics for Powerpoint
Limits:
Data not standardised
Dated (most recent )

8. LIMITATIONS
Reliable indicators for monitoring CVD and for which data are available on a comparable basis across EU countries are currently limited
Even mortality is scarcely comparable since the diagnostic criteria for coding death certificates are not standardized at international level and diagnostic information is not based on uniform criteria

9. CVD international sources include:
WHO-mortality
WHO-MONICA
EUROCISS inventory of population-based registers

10. LIMITATIONS
Reliable indicators for monitoring CVD and for which data are available on a comparable basis across EU countries are currently limited
Even mortality is scarcely comparable since the diagnostic criteria for coding death certificates are not standardized at international level and diagnostic information is not based on uniform criteria

11. CVD international sources include:
WHO-mortality
WHO-MONICA
EUROCISS inventory of population-based registers

12. Mortality data available
WHO HFA, EUROSTAT
Age: 0-64, 65+, 25-64,
0-14, 15-29, 30-44, 45-59, 60-74, 75+;
from WHO-HFA
0-84 by 5-year age groups, 85+, 0-64
from EUROSTAT
for CHD and STROKE

14. Participating countries
AUSTRIA
M. Kornitzer
DENMARK
M. Madsen
FINLAND
V. Salomaa
france
S. Paterniti
GERMANY
A. Doring
ITALY
S. Giampaoli, L. Palmieri, S. Panico,
F. Seccareccia, D. Vanuzzo
ICELAND
V. Gudnason
GREECE
A. Trichopoulou
M. Verschuren
NORWAY
POLAND
A. Pajak
PORTUGAL
E. Rocha
SPAIN
S. Sans
SWEDEN
N. Hammar UK
P. Primatesta
EUROPEAN HEART NETWORK
K. Steinbach
BELGIUM M
Participating countries
AUSTRIA
K. Steinbach – Austrian Hearth Foundation, Wien
BELGIUM
M. Kornitzer – School of Public Health, Bruxelles
CZECH REPUBLIC
J. Holub – Institute of Health Information and Statistics, Praha
DENMARK
M. Madsen – National Institute of Public Health, Copenhagen
FINLAND
V. Salomaa – National Public Health Institute, Helsinki
FRANCE
J. Bloch, C. Peretti – Institut de Veille Sanitarie, Saint Maurice
GERMANY
A. Doering – Insitute für Epidemiologie GSF, Neuherberg
HUNGARY
R. Adany – School of Public Health, Debrecen
ITALY (COORDINATOR)
S. Giampaoli, L. Palmieri, P. Ciccarelli, S. Panico, D. Vanuzzo, Rome
ICELAND
V. Gudnason – Iceland Heart Association, Kopavogur
GREECE
A. Trichopoulou – School of Medicine, Athens
The NETHERLANDS
M. Verschuren – National Institute of Public Health and E. Bilthoven
NORWAY
S. Graff-Iversen – Norvegian Insitute of Public Health, Oslo
POLAND
A. Pajak – Institut of Public Health, Krakow
PORTUGAL
E. Rocha – Insituto de medicina Preventiva, Lisbon
SPAIN
S. Sans – Institut d'Estudis de la Salut, Barcelona
SWEDEN
N. Hammar – Karolinska Institute, Stockholm UK
P. Primatesta – Univ. College London Medical School, London
EUROPEAN HEART NETWORK
S. Allender – University of Oxford, Oxford
the NETHERLANDS
S. Graff-Iversen
P. Primatesta

15. The map….

16. To prioritise cardiovascular disease of major interest in EU countries
Main objectives
To prioritise cardiovascular disease of major interest in EU countries
To provide a list of specific indicators and sources of information for monitoring CVD
To prepare the Manual of Operations for the implementation of population-based registers of acute myocardial infarction/acute coronary syndrome, stroke and of CVD surveys

17. EUROCISS Recommendations for mortality indicators
AMI: ICD10 codes I20-I21 (ICD9: 410)
IHD: ICD10 codes I20-I25 (ICD9: )
CVA : ICD10 codes I60-I69 (ICD9: )
Ischaemic STROKE : ICD10 code I64 (ICD9: 434)
Haemorragic STROKE :
(Intracerebral) ICD10 codes I61, I62 (ICD9: 431, 432)
(Subarachnoid) ICD10 code I60 (ICD9: 430)
Age: 35-44, 45-54, 55-64, and 75-84
Indicators should be standardised by age and gender using the European standard population

18. Population-based specific AMI Registers: population characteristics
Country
Years
Age range
Population
x 1000
Accessibility
Belgium
Charleroi
Ghent
25-69
25-74 (Ghent)
100
142 (Ghent)
School of Public Health/University of Ghent
Belgium Bruges
25-74
151
Univ. of Ghent
Northern Denmark
All
494
Aarhus Univ.
Finland
35+
193
KTL
France
35-74
1,519
INSERM U780
Germany
407
GSF – KORA
Italy
3,600
Institute of Health
Norway
1,000
Health Region West
Spain
480
Institute of Health Studies
Northern Sweden
322
MONICA

19. Population-based specific AMI Registers: case definition
Country
ICD version
Mortality
ICD codes(*)
HDR
Linkage
Mortality / HDR
Validation
Belgium
IX, X
, 428, 799
, 428
PTCA, CABG
Name, date of birth
ECG, enzymes, symptoms, MONICA
Northern Denmark X
410 ID
No validation
Finland
410, 411, 428,798, 799
410, 411
MONICA, troponin
France
, 428, 798, 799, others
MONICA
Germany
, 798,799
Italy IX
Norway
Troponin/CKMB levels
Spain
Northern Sweden – MONICA
(*) all codes are presented in the ICD-9 revision to facilitate the comparison

20. International sources of data

21. WHO Global Infobase
a data warehouse that collects, stores and displays information on chronic diseases and their risk factors for all WHO member states

22. Risk factors included in InfoBase
Alcohol
Blood Pressure
Cholesterol
Diet - Low fruit and vegetable
Overweight & Obesity
Physical Activity
Tobacco

27. Asia-Pacific Studies Collaboration

28. Asia Pacific Studies Collaboration - APCSC
Individual patient data meta-analysis from existing longitudinal studies with information on cardiovascular disease in the Asia Pacific.
The project's main research themes are:
risk factors for cardiovascular disease
interactions between risk factors for cardiovascular disease
prevalence and attributable risk for five major cardiovascular disease risk factors
the relationship of cancer incidence to cardiovascular disease risk factors
over 650,000 participants, 44 separate cohort studies in mainland China, Hong Kong, Taiwan, Japan, South Korea, Singapore, Thailand, New Zealand and Australia.
35 papers from the project have been published or are in press in international peer reviewed journals.

29. International - Global Burdens of Disease Project (GBD)
WHO Project, commenced 1992
World Bank, Harvard School of Public Health
Comprehensive and consistent set of estimates of mortality and morbidity by age, sex, region for world for first time for 1990
New measure – DALY (Disability Adjusted Life Year) – includes premature deaths and disability, weighted by severity of disability

30. GBD
Only 1/3 estimated 56 million deaths occurring annual are recorded in vital registration systems
Uses estimates from these plus disease registers, population surveys, epidemiological studies to “fill in the gaps”